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[CPAP] Newbie looking for assistance
#1
Newbie looking for assistance
Hi,
I am a newbie at this, so please forgive if I’m not in the right section, and ask too many questions.


I am a 75 year old male who has been using a Resmed Airsense 10 machine for close to two months, starting with the Autoset unit. After using it (trial) for a while, my respiratory therapist said I did not need the auto setting and that a fixed pressure unit would suffice. Since that time, a couple of weeks or so, I have been on the Elite version. For us in Canada, the Autoset is about $360.00 more than the Elite. Although I do not have insurance coverage for any part of this, I would be more than willing to pay the extra, if needed. A sleep study has been recommended, but no date has yet been set.


As to whether I am feeling any benefits, I should first mention that I have been dealing with polymyalgia for the past year, for which I have been taking Prednisone. I have been reducing the dose, (currently 3mg) and believe I see the end. For a long time, I was unable to do much work around the house, which is unusual for me, despite my age. However, I am now able to return to some of the renovations projects, etc, which were impossible a short time ago.
SO – is it because of sleep therapy benefits? Very possibly, but the picture is rather blurred by the polymyalgia.


I use the Oscar software, (which is brilliant) and review the info daily from the SD card, as well as that provided by ResMed.


The median AHI for the past 30 days is 8.41, average hours used 7.25 (data from ResMed).
The best AHI was 2,7, worst around 19.
An original test to determine whether I had a sleep apnea problem returned a reading of 42.


From the screen captures included, would you concur that the fixed unit is sufficient?
Also, do the pressure settings appear suitable?
Is it likely that an ASV unit will be reqd?


I would appreciate any assistance you can provide. I have learned a lot just by reading others’ comments.


Thank you.


Mike

               
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#2
RE: Newbie looking for assistance
We need to see some information in the left column, which means your pie chart must go.  Somewhere (I'll scout around for a link and come back to insert it if I'm not beaten to it by another well-wisher), there is an instruction on how to arrange your charts in OSCAR so that they are most beneficial for those wanting to help.

Meanwhile, and because we don't have much information this is just a SWAG, your machine is not currently doing you a whack of good.  Some, not a whole lot.  You may have to get that auto machine after all, but we'll know more once you sort out your chart and post them.

Edit: Here is the link to organize your charts: http://www.apneaboard.com/wiki/index.php...ganization
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#3
RE: Newbie looking for assistance
Two months is still a new user and the CA could be pressure induced. Give it another month, or so. If they don't resolve, you will need to discuss this with your doctor. You may need a sleep study on a different machine, called an ASV.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#4
RE: Newbie looking for assistance
Hi, all,
thank you for responding so quickly.
Still trying to find my way around.  
The "File" etc section is missing from my Oscar layout.  Did a copy/paste. Hope it helps.

Sorry if I miss thanking the right persons.  I'll get the hang of it!

Regards

Mike

   
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#5
RE: Newbie looking for assistance
Your AHI consistently being over 5 is IMHO unacceptable. 

You have a fairly high level of Flow Limitations and some logged RERAs, and I'm sure a number of unlogged RERAs.  RERAs are a series of flow limitations that end in arousal.  Needless to say, arousals are not good, they disrupt sleep.  Pressure Support (PS) is effective in treating these, likely in excess of 4 CMW.  Unfortunately, your machine does not use pressure support, so we will have to trick it.  We do have EPR which is limited to 3 cmw.  

PS, pressure support is simply the difference between inhale and exhale.  EPAP or Exhale pressure is what treats your Obstructive apneas so we really want to leave that alone.  EPR subtracts from IPAP/Inhale Pressure/Pressure in CPAPs so 11-EPR (3) = EPAP = 8.  This is 3 cmw BELOW the pressure we want EPAP to be so we also increase IPAP (your pressure) by 3 to compensate, so Pressure = 11 + 3 (EPR) = 14.

So set your pressure to 14 and EPR to on full time and EPR = 3  This will make your inhale pressure 14 and your exhale pressure 11.

Why buy an Auto
http://www.apneaboard.com/wiki/index.php...ine_Choice

in short because they will respond to a changed situation without being manually altered.  This change may be simply changing position from side to back, or congestion causing a partial obstruction.  or a new pillow or a strange bed.  ALL changes to the Elite must be made manually.

You can always ask your RT to make the changes, I'm sure he will love that you want to ad 3 cmw to your machine "for no reason", (I've explained my reasoning) and throw on EPR to compensate.
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#6
RE: Newbie looking for assistance
Get your doc to get you into a sleep clinic asap! Why are you on a machine without a prescription? BC health covers that study (I could be wrong, but OHIP does in Ontario)!
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#7
RE: Newbie looking for assistance
Thank you, bonjour, so very much.
You and the other members have been very helpful, and have
given me lot to think about.

I think I need to at least go for the Autosense.  What about a BIPAP?

Thanks again for all your time

Regards

Mike
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#8
RE: Newbie looking for assistance
To Trailrider,
thanks for the response.  I am retired, and neither my wife nor I have paid for the insurance for this.  BC does not cover it by default.
Regarding the prescription, this was done with a doctor's prescription, so that bit's covered. 
Currently I am waiting on the doc. to give me a date for the sleep study.
My AHI has been in the 3 range, but mostly higher than 5.  Can't predict from night to night.

Thanks again
Regards
Mike
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#9
RE: Newbie looking for assistance
If you haven't bought the elite, I would hire for another month and then do the sleep study. To see if the CA resolve. An autoset may not be the machine you need either. ASV are expensive but if that part, CA continues at 5, it may be advised, by your doctor. Or you may seek another opinion.

The elite can be adjusted, it's just a bit slower and 1cm at a time. Properly set up, there is no need for an auto.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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